Highmark to Use Epic Payer Platform, Google Cloud to Ease Collaboration

Feb. 27, 2024
Pittsburgh-based insurer says payer-derived insights delivered to existing provider workflows in Epic give a more complete view of a patient's health

Pittsburgh-based Highmark Health says it is collaborating with Epic and Google Cloud to better support coordination across payers and providers.

Epic's Payer Platform is designed to ease collaboration between insurers and healthcare providers. Highmark said that by connecting to Google Cloud, the insights shared with payers and providers can be used to inform consumers of the next best actions in their care journeys.

More than half of Highmark's 7 million insurance plan members are currently attributed to an Epic provider. For every attributed member, Highmark said it anticipates closing approximately 2.5 care gaps automatically, with upwards of 300 percent potential increase in care gaps closed.

Highmark Health's 14-hospital provider system, Allegheny Health Network, estimates this shared claims data will amount to $2.7 million in annual savings, which can be reinvested into quality clinical care and patient experience.  

Highmark said the from a clinician's perspective, payer-derived insights delivered to existing provider workflows in Epic give a more complete view of a patient's health. These insights can include a patient's conditions, history of in- and out-of-network visits, health plan benefits and programs available, insurance claims, alerts for acute events, decision support, and care management.

"Epic's Payer Platform is a powerful resource that enables payers and providers to work more effectively together. Pairing that resource with Google Cloud's technology gives Highmark Health the ability to change the paradigm," said Tony Farah, M.D., executive vice president, chief medical and clinical transformation officer for Highmark Health, in a statement. "It's another step forward in achieving better experiences for both consumers and clinicians, while improving health outcomes and lowering cost of care."

Google Cloud data analytics technologies, such as BigQuery and Healthcare Data Engine, will facilitate insights shared with provider partner organizations that use Epic, Highmark health plan staff, and Highmark members through other integrated digital channels such as the patient portal.

"Highmark Health's use of Google Cloud will enable the organization to create an intelligence system equipped with AI to deliver valuable analytics and insights to healthcare workers, patients, and members,” said Amy Waldron, director of healthcare and life sciences strategy and solutions for Google Cloud, in a statement. “Highmark Health's investment in cloud technology is delivering real-time value and simplifying communications; it's redefining the provider and consumer experience."

Highmark added that automated information sharing can trigger actions to improve health outcomes, such as creating a case for authorization, prompting acute care concurrent review, or initiating transitional care. In addition, health systems working with Highmark can leverage health plan-calculated care gap statuses to initiate actions that achieve gap closure, to avoid unnecessary outreach, and to understand quality performance outcomes from the health plan's perspective.

Using Epic’s Payer Platform, notification can occur when a patient has an event, such as an arrival to the emergency department, an admission, a patient class change, or a discharge. Health plans often request to be notified when a member has been admitted to or discharged from a hospital. Without technology such as Epic's Payer Platform, health systems administrators typically engage in time-consuming points of connection, like making phone calls or sending faxes.

"Leveraging automation for responsible data sharing is a game-changer, especially when it comes to reducing the administrative burden of relaying clinical information in various directions—to payers, providers and customers," said Richard Clarke, Ph.D., senior vice president and chief analytics officer for Highmark Health, in a statement. "It facilitates informed decisions without the need for manual back‐and‐forth, all within the confines of Highmark's secure Google Cloud infrastructure."

In addition to Epic's Payer Platform, Highmark Health said it is deploying a suite of tools to improve digital enablement of provider partners, including a new provider resource center and provider portal powered by Availity.

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